End-of-Life Care of Young Adult Solid Organ Transplant Recipients Compared to Nontransplant Recipients

Abstract

Introduction

Little is known about end-of-life care of young adult solid organ transplant-recipients and how it compares to care received by nontransplant-recipient young adults with chronic illness.

Research Questions

(1) What aggressive and palliative care methods are used among young adults by solid organ transplant status (ie, recipient vs nonrecipient), and (2) what factors, including transplant recipient status, predict receiving a palliative care consult in the last 90 days of life.

Design

Data on young adults (18-39 years) with a history of solid organ transplant (recipient cohort) or cancer, heart disease, and/or HIV (nonrecipient cohort) were obtained from the clinical data warehouse of a large academic medical center/primary transplant center. The nonrecipient cohort (n = 412) was propensity score matched to the recipient cohort (n = 412) on gender, race, and age at death. Aggressive care was the use of cardiopulmonary resuscitation (CPR), dialysis, tube feedings, emergent intubation, extracorporeal membrane oxygenation, and mechanical ventilation. Data on receipt of and reason for palliative care consult were also extracted, and logistic regression was used to identify factors associated with receiving a palliative care consult.

Results

A larger percentage of nonrecipients received CPR (36.0% vs 20.0%, P < .01) and emergent intubation (16.8% vs 6.1%, P < .01), whereas a larger percentage of recipients received dialysis (31.7% vs 19.9%, P < .01). A larger percentage of palliative care consults for symptom management were noted in the recipient cohort (49.2% vs 22.2%, P = .04).

Conclusions

Similarities in care between the cohorts may indicate transplant recipient status does not impact end-of-life care in young adults.